醫療照護相關退伍軍人病防治策略

Prevention and Control Strategies for Healthcare-associated Legionnaires’Disease

醫療照護相關退伍軍人病死亡率高達30–50%，在感染管制上相當重要。適當運用培養、抗原、及核酸檢測等診斷工具，能及早確立診斷，給予病人適當治療。預防醫療照護相關退伍軍人病感染的發生，最有效的方法為定期監測環境水體退伍軍人菌，並確實執行供水系統清潔與消毒措施。消毒方式包含物理方法如高溫消毒法、點過濾器，及化學方法如加氯消毒、銅銀離子、臭氧、紫外線消毒、過氧化氫等，各有適用時機。當醫療機構內發生可能與醫療照護相關病例時，應及時介入調查並採取緊急環境介入措施來防範感染事件擴大。對潛在暴露風險的用水設備進行工程控制及管理機制來減少有利於退伍軍人菌生長及繁殖的條件，是防治退伍軍人病最好的策略，同時臨床醫師也應保持高度的警覺性，降低退伍軍人病對病人的傷害。

Legionnaires’disease has a case fatality rate of up to 30–50% among healthcareassociated cases, highlighting this disease as an important infection control issue. A timely diagnosis and treatment of the disease could be achieved through the application of the appropriate diagnostic tools, including targeted culture, antigen, and nucleic acid tests. On the prevention of healthcare-associated legionellosis, the most effective interventions include regular environmental monitoring, as well as the application of cleaning and disinfection measures on water supply systems. Control methods include a physical reduction of Legionella species via temperaturebased methods or filters, and chemical disinfection via chlorine-based methods, cooper-silver ionization, ozonation, ultraviolet light, or hydrogen peroxide. When a case of legionellosis is suspected to be related to the patient’s healthcare settings, timely investigation and environment control measures are necessary to prevent ongoing outbreaks. The strict application of the relevant engineering controls and management approaches to reduce the growth of Legionella species in the water supply is the best strategy to prevent Legionnaires’disease, alongside physicians whose clinical alertness is necessary to mitigate its morbidity.